Friday, July 18, 2008

To Pull or Not to Pull?

We are currently faced with the decision of whether or not to pull Buddha's front teeth out. The wire splint was taken off this past Monday and the dentist who has overseen this whole trauma didn't seem too optimistic. She said the tooth is still really loose, but she seemed to think that it might solidify in place once the swelling around the nerves goes down.

Today, however, we took the boys to see their dentist, Dr. Baker, for the first time. He is their dentist because he accepts our dental insurance plan. Otherwise we might have stayed with the emergency dentist, Dr. Good, who initially took care of Buddha. Anyway, Dr. Baker says that both teeth have to be pulled and we have to shell out another $550+ for a baby bridge so that Buddha doesn't develop a speech problem. I was shocked, first of all because only one tooth was ever in question and now suddenly it's the two front teeth that are no good?! And second, because here we already spent $500 dollars trying to save the tooth. Dr. Baker says that the tooth was pushed back too far to have ever had any hope of saving it. And if that's the case, then I really don't know who to be more upset with - Dr. Good or Dr. Baker? Dr. Good shouldn't have tried to save the tooth in the first place if it was too far gone. And is this "baby bridge" that Dr. Baker is pushing really necessary? Or is he just feeding on parental guilt and protectiveness? Does anyone out there have any experience with this sort of thing? I need some advice here. I don't want to cause my child to develop a lisp or anything, but I'm also worried that we're being taken advantage of by these dentist who could be pushing sales over necessity. One of the assistants tried to sell me a $12 box of baby teeth wipes that I could "use on the little one until he's 4 or so and can use a toothbrush." I kindly thanked her and then informed her that my one year old already knows how to use a toothbrush and does very well on his own, thank you very much. $12 for 12 days of teeth wipes. Unreal!

16 comments:

Tough one. And I am hardly qualified. I will say that the dentist you saw most recently seems to have trained all of his staff on selling over-priced products. Insurance is frustrating as what right does an insurance company have to dictate who treats ourselves and our families, where we are treated, etc.? I am of the opinion these days that many medical professionals and hospitals are just a business like anything else. Sad but true! I would look in to whether there are any other dentists you could take Soren to for another opinion.

I trust my dentist, and I think he could take Soren, he's an lds and very gentle, the only thing is that he's in El Cajon!!! Anyways, I would wait, maybe the first one knew what she was doing and didn't try to take advantage for selling you things.... What do you have to loose waiting anyway? Not $500 maybe!!!

As a former dental assistant I'd say get a second opinion. A lot of dentists will always try to take your money. I'm no professional but the speech problem thing sounds a little like bull. My brother in law knocked out his two front teeth when he was crystal's age and never had them replaced, and just waited until his adult teeth came in. He's 17 now and speaks perfectly fine. Most dentist's will do everything they can to save the natural tooth cause there's no fake tooth that can compensate for the real thing. Is this dentist an adult dentist, or a pedodontist that works with kids? I've never seen a dentist put a bridge on a child with baby teeth before. If I were you I'd get a second opinion.

I agree. Get a "third" opinion. And definitly see a pediatric dentist. It really makes a difference. We saw a family dentist who told us Dane need a baby root canal. Thankfully he referred us to a pediatric dentist who was able to just put in a filling and not do a root canal. I don't think there is any rush...if its going to be pulled out might as well give it some time to see if it stabilizes. My little sister knocked out one front tooth and it wasn't a problem. However, two missing front teeth at this age could cause speach problems?? Good luck!

My niece smashed her mouth on my parents coffee table during our visit last Christmas. My sister took her to a dentist because the tooth was pushed back really far. The dentist said to watch the tooth and see if it turned a shade of gray ... if so, the tooth was dead and would need to be pulled. If not, the tooth was still viable and would be fine. I agree on getting another opinion too. Good luck!

So I just happen to live with a dentist and here is what he has to say (get your dictionary out because he uses words like contraindicated):

Hmmm, let's see. The scenario you described is very common. To say that either dentist is trying to "sell" you a treatment for your child is probably not true. The vast majority of dentists out there truly have your son's best interest in mind. These cases are rarely cut and dry. You might go to three different pediatric dentists and get three different opinions on how to treat the case. Based on your explanation, I would tend to say that both dentists acted appropriately. The first tryed to stabalize the loosened teeth, which was the proper thing to do, generally speaking. There are times when the bone surrounding the teeth is so badly fractured, or the teeth themselves are so badly damaged, that stabilization is contraindicated. Most of the time however, we splint and watch. A good percentage of the time the baby teeth will "heal" in a matter of speaking. Sometimes, for a variety of complex reasons, the teeth do not "heal." This would not have been evident to the first dentist until some time passed. As far as the second dentist trying to "sell" you a "baby bridge", again I tend to think he is just giving you a conservative treatment option. When a child looses his/her front teeth the tongue no longer has teeth to make sounds against such as "th" and "t" sounds. Over the course of the next 4 years or so until your son's permanent teeth come in, he could develop a lisp. (Remember, he is still learning how to talk, it would be different if he were an adult with set speech patterns.) Have you ever heard a kid without their two front teeth talk? Most children will learn to correct the lisp when their permanent teeth erupt, some won't. In short, it is unlikely that your son would develop a permanent speech problem due to prematurely extracting his baby teeth, but it is POSSIBLE and it does happen every now and again. The second dentist presented you with a treatment option that would eliminate that possibility. In summary, the opinions shared here are limited by the lack of details in the case. In these types of trauma cases, the exact details are very important to determine the best course of action. If you still feel like your dentist is motivated by motives other than the well being of your son, take him to a pediatric dentist for a third opinon. Better yet, send his xrays and treatment history to me and I will look it over and have a few pediatric dentists take a look as well. If you have any other questions, feel free to call. I promise I won't try to sell you any baby tooth wipes. Cody Nelson, U Pitt, Dental Med.

Wow..Lot's of opinions to sort through... Take your time. Soren has already mastered his speech..(didn't he do that when he was 2..hehee) A lot of my kinders go a long time without teeth and I don't see them slipping backwards. Your friends are right, you should see a pediatric dentist and go on prayer and your gut instinct. Good luck...B.

Both dentists we saw are pedodontists. In California, regular dentists won't see kids under the age of three or four. You have to see a pedodontist/pediatric dentist.

Cody, thanks for all your tips! One of the reasons I was skeptical about Soren getting a speech problem without front teeth is because he's already a great talker. He can say anything we ask him to say and talks all day long...incessantly. :) He's quite verbally advanced.

It's also interesting what you say about how you determine if a tooth is worth saving. This is another reason I'm a bit peeved with the first dentist. During a follow-up visit a couple days after the accident, she told me that when he had his accident, it not only pushed his tooth back, it also broke bone.

So here are my questions. What's the harm in letting his loose teeth stay in there? He already won't bite with them. He probably wouldn't bite there with teeth even, it's already so ingrained in him to avoid those teeth. The first dentist told us on Monday that he has inflammation around the nerves of his tooth. She believes this is from the trauma of his accident and hopes it will go down. The second dentist, today, said that three weeks after the accident this inflammation wouldn't be the result of trauma but infection. I asked him if we couldn't just treat the infection and then do a root canal. He gave me some round-a-bout answer about infection and then said a root canal can't even be given a 10% guarantee.

You know, I think maybe I will ask them to give me copies of his x-rays and treatment to send to you. I would appreciate a third opinion without having to pay up the wazoo for it. I just want a straight answer from someone I can trust. Then I'll know that I'm proceeding with the best interest of my son in mind. Thanks for being willing to help us out!

So, to answer your question: What's the harm in letting his loose teeth stay in there? The results of leaving his teeth in would likely be further pain and infection. Also if the teeth become loose enough, your child could aspirate the tooth (tooth could end up in right lung.) I am not quite sure how long it has been since his accident, but if it has been more than 4-6 weeks and the teeth are still mobile, they have a high probability of not reintegrating. To understand why this happens it is important to understand the body's reaction to trauma. (When teeth "die" as your son's have, there is a process the body predictably goes through. When his teeth were loosened, the blood and nerve supply to the inner portion (root canal) of the tooth was most likely severed. When this happens, all of the vital tissue that was inside the tooth itself dies. That dead tissue has to go somewhere. It "leaks" out the end of the tooth into the surrounding bone and you get pain, inflammation, and sometimes infection. If the teeth are left untreated, this usually turns into a chronic condition with periods of pain and swelling followed by periods of symptom cessation. As long as that dead tissue is being "processed" by the body, you will continue to have pain/inflammation/infection. Also, with trauma cases, you often have a secondary bacterial infection as well. The accompanying bone infection will often spread and damage more adjacent bone, propogating and exacerbating the infection to the point where the infection finally penetrates all the way through the bone and the "dead" tissue (at this point basically puss) leaks out into the mouth through a small opening. The generic term for this is a dental abcess. As far as being able to even do a root canal at this stage depends on how developed the roots of his teeth are. When a baby tooth erupts into the mouth, the roots are not fully developed. It takes about two years from the time the teeth erupt to fully develop the roots to the point where a conventional root canal would even be possible. There are different types of root canal treatments that can be done depending on the stage of development. Without seeing xrays and/or your son, I really can't render any opinion on the best course of treatment. Also, remember that if your dentist prescribes antibiotics or steroids to help with infection/inflammation that is only to help alleviate the problem.

As far as Soren not developing a speech problem because he is a jabber box and seems to be ahead of the speech curve for his age, I would say that it is very difficult to tell how he will respond based on his current level of development. Even though he may be advanced FOR HIS AGE, he is still LEARNING to talk. Remember there are several stages to speech development. These stages do not complete until early adolescence. Children obviously loose teeth all the time and do not develop speech problems. The key is when they loose the teeth and how long the teeth are missing for. In his case he would be without teeth at a very critical time, for a period of YEARS. It may not affect him at all, but it may.

Finally, I hope my rambling answer helps you to see the complexity of the problem. This is not a "cook book" situation where child breaks tooth so dentist does x,y,z. There are many variables here. My explanations are more general guidelines for you to try and gain some insite as to why the dentists have proposed the treatment they have. Get a copy of the Xrays and have them sent to me with the best digital pics of Soren's teeth you can manage. There is only so much I can tell you without being able to examine him myself. I hesitate to tell you what to do here, becuase without having the patient here to examine, it would be very easy for me to misdiagnose or propose incorrect treatment. I am basically relying on your explanation of what happened and what the dentists have done to piece togethere what is probably going on. I am basically trying to tell you that getting a "straight answer" to this complex problem might not be as straight forward as we would like. The best I can do is tell you what I would do if the same situation happened to my child. Anything I tell you should be discussed with your Pedodontist. If you have any other questions, feel free to call, I am a terrible writer and tend to ramble. If Brooke were writing this, it would be witty and funny (so far as this topic would allow.) Looongg story short: Leaving traumatized loose teeth to "hang out" in the mouth = bad idea.

I'm glad you have a "real" dentist to bounce ideas off of. I agree that a third opinion is good. Especially when the first two were so different.That is what I would do. In the end.... if it came down to paying and having fake teeth, or leaving a hole. I asked my husband what he would do and he would say he would pay the $500. I think I would too.Now that's on the condition that we actually have the $500 and didn't have to borrow it. etc. We had the same dilemma with Roman's head as an infant because he developed a flat spot on the back of his head and although there are no ill side affects to having a flat head your whole life, it's still not "normal" so we paid $1500 for a shaping helmet. I'm still glad we did. It was a painful $1500 but I still feel like it was worth it. Even though one Dr. said, "it might correct itself" and "it's not affecting his face or anything". It was pretty bad and the helmet helped a lot. Even though I went against the Dr.'s advice not to worry about it. We changed Dr's and the next dr said he absolutely would have recommended it.

Actually - Ramsey has had a similar problem and both of his front teeth have reattached... not to say that Soren's will for sure. But my first thought is to see a pediatric dentist (a 2nd opinion). My ped. dentist here is excellent -his major concern for Ram was reoccuring infection but we seem to be avoiding that. The second relevant concern is position of the loose teeth (have they damaged the adult buds inside his gum)?

Again, I would seek another opinion. And trust your instincts. I know that sounds corny but it has never failed me - 4 kids and dragging them all over the world. Call me if you want and I can tell you more about what I do know - or I have a dear friend who is a dentist and just sold her practice down near you - I could ask her for a good name... Let me know. -So sorry about this.

I think you should get another opinion. Is there someone else who takes your insurance plan? I would be frustrated too. It is a lot of money on the table. It is really sad that there are people who like to take advantage of others. It is almost always about the money. I would pray about it.

Liz-Go see our dentist if you need a second opinion, they totally rock and are super gentle and sweet. Oh, and don't ever go to any more of those Larson birthday parties:) They sound like trouble!-Heather

I have no advice. Just sympathy. It seems every time I go to the doctor I face this problem. Are these tests really necessary? Do I really need them? Does Ava really need them? Part of me suspects that the doctors just want my money and the other part of me suspects that my doctors are just trying to save themselves from lawsuits. Poor you. Maybe you should get a third opinion.